| NPI | 1376289850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TN 5797) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 008908) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2023-03-10 |